A holistic effort has been made in the book titled “Discrimination against the mentally ill” by Monica A. Joseph to contribute to increased awareness and sensitivity toward discrimination against the persons with mental illness and to lay out some of the potential ways to prevent this form of discrimination. Mental illness, as discussed by the author, has historically been called by “a variety of different names – madness, insanity, lunacy …, unsoundness of mind, idiocy, and imbecility” (p.5). She further adds that the mental illness, as a concept, in the contemporary era “is most often used interchangeably with mental disorders” (p.5). The illness itself is a bane for the person concerned. Discrimination against such people adds more miseries into the existing misery that they are already languishing with. Over and above that discrimination tampers fundamental human rights of the mentally ill persons. This form of discrimination is a grave concern for the whole humanity as it raises n-number of immoral issues.

Along with presenting a comprehensive view of the given issue by integrating discussions on its historical background and the key reasons, the book offers various Acts and the degree of enforcement of these Acts. Stress has also been laid on the view that discrimination against the persons with mental illness is widespread across the globe. As the author points out, discrimination has been pervasive in almost every aspect of the lives of the persons with mental illness for more than two centuries. It is hard to believe that the perpetrators of such barbaric act, as she adds, includes not only the entrusted physicians and nurses but also the family members of those affected persons. This book also examines some of the contemporary issues that persons with mental illness are dealing with, including the intersection between comorbidity, the criminal justice system, and diversity. Apart from that, the author proposes that there must be a conscientious effort along the lines of prevention from each member of the society to get rid of this age-old medico-social issue – as it hampers the well-being and growth of society as a whole. Further, each member of the society is required to come forward and deliberate specific corrective measures to “decrease the stigma of mental illness, while ensuring that any form of discrimination is promptly addressed” (p. xvi).

The book has been structured with three parts. Part I offers an overview of the issue, spread across six chapters. Part II deals with controversies surrounded around the issue of discrimination, discussed in three chapters. And, Part III presents a compendious view of the resources which will assist a reader in knowing about the breadth and depth of the issue. The set of resources includes the various websites, books and journals, articles, and relevant documents on ‘attitudes towards mental illness,’ ‘chancery lunatics,’ ‘The Americans with Disabilities Act (ADA) of 1990,’ ‘The Mental Health Reform Act (MHRA) of 2015,’ and ‘what a difference a friend makes anti-stigma campaign.’ Apart from that to help the readers have clarity in understanding of the content, the book offers a glossary of key and technical words. The most appealing item that the author has presented in the book, in this Part III, is the timeline of incidents, history, and background of the issue in detail which would help a reader visualize a broader view of the issue.

Having written with lucidity, the book has an attractive way of discussing one of the thoughtful medico-social issues with the help of various definitions, examples, situations, controversies, and various Acts aligned with the issue. The flow of content across the book is excellent, quickly readable, and easily understandable. The book is useful for any researcher dealing with ethical vis-à-vis unethical issues surrounded around the discrimination against the persons with mental illness. It is said so because along with providing an extensive and holistic view of the issue, the author has furnished the critical resources which will enable the researcher to go beyond what the author has tried to achieve through the book. After going through the book, I have realized that I can incorporate the issue “Discrimination against mentally ill persons” in my course on Contemporary Moral Issues. Without any reservation, I could vouch that the book will proffer various perspectives on the issue which would help me in introducing the issue clearly and in generating debate and discussion amongst the students in the classroom.

The following sections are going to present brief chapter-wise discussion. Chapter 1 starts with the background and definition of ‘mental illness,’ followed by giving an extensive discussion on the background and definition of ‘discrimination’ and that of ‘discrimination against mentally ill persons’ leaning on current data on mental illness drawing from developed as well as developed nations. The prime focus of chapter 2 is to deliberate on the belief systems and historical treatment of the mentally ill. The author puts forward an important point in this chapter that “religious, social, physical, medical, and more recently, behavioral interventions used to treat persons with mental illness have been influenced by our changing beliefs and attitudes” (p.17). In this context, the chapter outlines various forms of beliefs, such as ancient beliefs, medieval beliefs, modern beliefs, reformation, beliefs in the age of reason, and early American beliefs. It examines these beliefs to demonstrate how the mental well-being has evolved into what we have today. Chapter 3 discusses the issues about discrimination and formation of a modern system of care for the mentally ill. Questions like ‘who was responsible for persons with insanity?’ and ‘who would bear any cost associated with their treatment, and for how long?’ etc. have been discussed to draw the attention of the lawmakers, academic thinkers, and medical practitioners. The chapter also analyses various Acts about such questions.  

Chapter 4 tries to bring forward the healthy relationship between early American society and discrimination against the mentally ill, by illustrating the issues ingrained in ‘almshouses, poorhouses, and workhouses in the United States’ and ‘early hospitals and asylums in the United States.’ An effort has been made in chapter 5 to show how the treatment movements have influenced discrimination against mentally ill persons. As the author discusses, the treatment movements were affected by discriminatory practices and attitudes happened in ‘movement toward physical treatment,’ ‘the medication management movement,’ ‘the public health movement,’ and ‘the behavioral health care movement.’ The chapter also discusses various issues under the stances, such as a) ‘approaching mental illness as public health,’ like how the public health approach affects discrimination, b) ‘approaching mental illness as disability,’ and c) ‘approaching mental illness as behavioral health issue.’ After elucidating the main issue by taking various definitions, perspectives, Acts, belief systems, and the discriminatory practices and attitudes towards the mentally ill persons, the author puts forward different forms of discrimination against the mentally ill and the influence of diversity through chapter 6. Along with that, the chapter discusses the fundamental human rights of mentally ill persons and how these rights are affected. 

Chapter 7 puts forward various controversies related to the issue of discrimination against mentally ill persons like comorbidity which refers to “the presence of two or more medical conditions in an individual” (p.111). Also, the chapter presents the controversies surrounded around the relationship between ‘mental illness and other chronic health disorders,’ ‘mental illness and gambling,’ ‘mental illness and neuro-developmental disorders,’ and ‘mental illness and the PTSD – the veteran connection.’ Chapter 8 introduces the concept of ‘criminally insane person.’ Along with that, the chapter discusses how to deal with criminally insanes with the help of criminal justice system. There is also a portrayal of the issues involved in ‘rehabilitation and punishment,’ ‘post-incarceration resources,’ ‘voluntary and involuntary commitment from the patient’s side,’ ‘mandatory medication management,’ etc. Eventually, the book, through chapter 9, presents the ways to prevent discrimination against mentally ill. Though the author discusses various ways that can be taken to prevent discrimination, the question ‘can we prevent discrimination against mentally ill persons?’ or “is discrimination against the person with mentally ill preventable?’ is still open for contemplation and debate.

© 2018 Biswanath Swain

Dr. Biswanath Swain, Assistant Professor, Area of Humanities and Social Sciences (Ethics),Indian Institute of Management Indore, Indore, India